Health inequalities are worsening across Europe, says WHO

BMJ 2013; 347 doi: (Published 31 October 2013) Cite this as: BMJ 2013;347:f6594
  1. Anne Gulland
  1. 1London

Despite improvements in health overall in Europe, health inequalities are worsening, a report by the World Health Organization has found.1

The report, which covers the 53 countries of WHO’s European region, warned that the global financial crisis has brought “conditions of great hardship to parts of the region.” It said that the crisis was more “profound and extended than most people predicted” and “exposed stark social and economic inequities within and between countries.”

Health inequities are worse in the eastern part of the region, said Michael Marmot, chairman of the review and director of the Institute of Health Equity at University College London, in the foreword to the report.

He added, “Although social and economic circumstances have improved in all countries, differences remain and health has suffered, particularly in those countries to the east of the region. Even the more affluent countries have increasingly seen inequities in people’s life conditions and declining social mobility and social cohesion. As a likely result of these changes, health inequities are not diminishing, and are increasing in many countries.”

The review recommends universal, high quality, and affordable education and childcare for preschool children. It said that early years education was an important determinant of good health and development outcomes, particularly among disadvantaged children. However, in many eastern European countries the poorest children do not have access to this education or care. In Montenegro, for example, around 90% of the poorest children aged 3-6 years do not have access to good early years education, whereas 40% of the richest children don’t.

The review also highlighted eastern Europe’s poor record on child poverty and said that despite 10 to 15 years of economic growth before the current recession child poverty has remained static. It attributed this to the fact that average expenditure on family benefits in this part of the region was less than 1% of gross domestic product, less than half the 2.25% on average in the member states of the Organisation for Economic Co-operation and Development.

However, in western Europe child poverty rates ranged more widely in 2009, with 24% of children in Italy classed as living in poverty but only 10% in Iceland. And in 11 countries—Latvia, Bulgaria, Greece, Hungary, Malta, France, Germany, Sweden, Finland, Denmark, and Norway—child poverty increased between 2005 and 2009.

The report also warned of the consequences of high unemployment, saying that “material deprivation resulting from unemployment or low-paid work . . . contributes to physical and mental ill health.” The report highlights the high level of unemployment among people aged 15 to 24 relative to the general population. In Bosnia-Herzegovina nearly 60% of this age group were unemployed or not in education, compared with around 25% of the general population. The picture is similar across most of the European region.

Marmot said that unemployment, particularly among young people, was a “public health timebomb waiting to explode.”

He added, “I would say to any government that cares about the health of its population: look at the impact of their policies on the lives people are able to lead and, more importantly, at the impact on inequality. Health inequality kills. It is socially unjust, unnecessary and avoidable, and it offends against the human right to health.”


Cite this as: BMJ 2013;347:f6594